Beautiful Things

by Hunter Biden

  Beau insisted he was fine. But he was clearly struggling, hunched over and unstable. We drove him to the local hospital, where technicians were about to perform an MRI when he had his seizure. It was terrifying, like something out of The Exorcist. The violence erupting inside his body was being expressed in convulsions and contractions; you could almost literally see the storm raging inside his brain. It seemed to last forever. I felt helpless: I wanted to absorb my brother’s pain, yet there was nothing I could do.

  Nothing.

  When the storm finally passed, Beau was rushed by air ambulance to Northwestern Memorial Hospital in Chicago. His wife, Hallie, and I followed in my car, racing the whole way, making the seventy-minute drive in half the usual time. Beau had undergone an MRI by the time we arrived. The doctor showed us the images.

  I was relieved. I’d looked at so many brain images since Beau’s stroke that I thought I knew exactly what was going on.

  “That’s just the infarct,” I said, referring to the part of the brain damaged by the stroke. It showed up as a dingy shadow.

  The surgeon, one of the best in the country, let out a sympathetic sigh.

  “Hunter,” he said solemnly, “I think it’s a tumor.”

  “No way,” I insisted. “It’s exactly… I’ve been looking at these images for over a year now. That’s where the stroke occurred—exactly where it occurred.”

  “Well, I don’t know about that,” the surgeon said. “But this looks like a tumor.”

  We flew Beau home and took him to Thomas Jefferson University Hospital, close by in Philadelphia. The tumor was confirmed.

  A few days later, Beau and I boarded a plane for Houston to meet with a brain surgeon at the University of Texas MD Anderson Cancer Center.

  * * *

  Glioblastoma multiforme is a mean, relentless horror. Doctors told Beau after his first surgery that it had been successful, that they’d removed all of the tumor they could see, but that it was the most aggressive type of cancer—a worst-case scenario. Nobody gave Beau the numbers—the odds—but I asked about them later when it was just Dad, me, and the surgeon in a room. I then looked it up online to make sure the survival rate he gave us was correct: less than one percent. Patients generally live from fourteen to eighteen months after diagnosis, and few who last longer than five years live with what’s considered a bearable quality of life.

  It was a death sentence.

  I went quickly from disbelief to anger, sure that doctors had missed the tumor back when they’d determined he’d suffered a stroke. Would it have changed outcomes if they’d found it earlier? That’s a different, unanswerable question.

  Now Beau and the rest of us found ourselves in the same irresolvable position many patients and families find themselves in after such a long-odds prognosis. We doubled down on what was almost surely a losing hand. Incapable, or unwilling, or just too damn scared to do otherwise, we adopted a fighting optimism about whatever procedures Beau’s doctors recommended. Over the next twenty-one months, those recommendations included two more major brain surgeries, chemotherapy, and brutal radiation treatments—all, in the end, to no avail.

  If I had to do it over, I never would have agreed to put Beau through the standard protocol, especially the radiation. Given the infinitesimal chances of his coming through it anything like he was before, and the pain and deficits it inflicted—difficulty talking, inability to put on shoes—it was almost barbaric. Yet in that moment, when you’re in the hands of such brilliant, dedicated, and empathic professionals, even the slimmest chance seems worth pursuing.

  Our final recourse was a high-risk, uncertain-reward option: the injection into his brain of a biological agent being developed by a research oncologist with funding from MD Anderson. We knew the chances of it reversing his cancer’s advance were less than de minimis, yet we hoped for a miracle.

  Hoping for a miracle is an oxymoron. By definition, a miracle is something a rational person can’t rely on. So it takes a kind of dogged compartmentalizing to divorce yourself from rational thought at a time when you’re immersed in nothing but calculated and rational decisions. In Beau’s case, that meant everything from scheduling his procession of doctor’s appointments to monitoring his diet to determining who was going to help him get dressed. Those banalities soon piled up into a kind of makeshift altar to the mystical, the magical, the unaccountable. We knew this procedure was a last resort—a true Hail Mary.

  The time leading up to that final desperate measure, and the relatively short period that followed, also would be the last sublime stretch I spent with my brother.

  * * *

  Beau and I flew to Houston together the week before that last surgery at MD Anderson. We stayed in a hotel suite about a mile from the hospital, trekking there each day for the battery of tests and medicines needed to prep him for the procedure. Mom and Dad would arrive the day of the operation.

  Beau had lost function to the degree that I had to put his socks and shoes on him, help him with the toilet, aid him in and out of the shower. We got in an argument shortly after we’d landed in Houston when I tried to set up an app on his phone to help him regulate his breathing, which had turned fickle. Beau got frustrated with himself when he couldn’t do it the right way, then thought I was getting frustrated with him. It broke my heart that I needed to convince him otherwise: watching my older brother unable to follow instructions for something as basic as breathing in and out left me devastatingly sad.

  Our time together that week alternated between a kind of biding quietude and laughing at the dumbest damn things. We didn’t engage in heavy, this-could-be-it conversations; we never handicapped the procedure. We didn’t make what-if preparations. We both knew intuitively what had to be done. Beau simply would not allow himself to plan for the worst. The rest of us took our cues from him.

  Dad, as always, called constantly, asking if everything was all right and if there was anything he could do. My answers were almost always the same: yes, and no. He read into those responses what he needed to: in choppy times like these, he, Beau, and I could communicate through a kind of nonverbal frequency we’d developed during previous setbacks and tragedies. Saying much more risked breaking the spell and going to a place none of us wanted to go.

  It wasn’t as if we hadn’t weighed more realistic thoughts. They just didn’t need to be articulated right now. It wasn’t like I didn’t know what Beau wanted for me, or that I didn’t know what I needed to do. It wasn’t as if he had answers that I was failing to grasp, or vice versa.

  One topic we did discuss aloud was how to handle his running for governor of Delaware after his surgery. Politics are in the Biden bloodstream. The current Democratic governor was term-limited, and Beau had announced the year before that he wouldn’t seek reelection as attorney general so that he could focus on the 2016 governor’s race. The unusual move to leave public service while seeking another position two years later fueled speculation about his health. We all knew the statistical probabilities of his diagnosis, but Beau approached it as if the treatments were going to work, and so we all acted likewise—damn the odds.

  We remained more than hopeful about everything all week. That mindset was something beyond superstition for Beau. He made his way to the hospital each day like a pilgrim visiting some sacred site, convinced only good would come of it—that he could be cured. The doctors and staff, most of whom we knew well from his previous two surgeries there, became almost saintlike figures capable of transcendent things.

  I recall especially Beau’s fascination with the anesthesiologist, a great guy who had the most piercing blue eyes—eyes the very same blue, in fact, as my brother’s. He intrigued Beau, and Beau talked all the time about the calming effect those eyes had on him. They were the last things Beau saw before the commencement of his two earlier craniotomies, and the first things Beau woke or became alert to afterward. The same anesthesiologist also sedated Beau before MRIs because of his fear of tight spaces. The two of them seemed
to share some unspoken understanding as they stared into each other’s identical deep-blue pools.

  Back at the hotel, we laughed at the same things we’d always laughed at. I lay in bed with Beau while we streamed movies and TV shows on my laptop, staying there beside him until he drifted off to sleep. We binged Curb Your Enthusiasm and Eastbound & Down, both favorites of Beau’s that traded on the sort of demented humor he ate up. But even then, he laughed a little less than he used to, seemed a little less amused. It became harder for him to follow storylines and maintain a sustained interest.

  We didn’t leave the room much—sometimes we ate downstairs at the hotel restaurant, one night we went out to see a movie, and another day two friends of Beau’s surprised him by flying in for a visit. One afternoon we ventured into a nearby western-wear store. It was heartening to see some of Beau’s humor peek through. He picked out a matching set of ridiculously bright red western shirts—they had buttons that snapped, making them easier for him to put on by himself—and he paired them with new blue jeans. I tried to convince him to get a cowboy hat, too, but he wouldn’t bite. He wasn’t that far gone. I bought it instead.

  I cherished the hell out of that week. Looking back on it now, I see much of it as a ritual we both performed to prepare us for what was to come.

  * * *

  At first, everything seemed to go well. We hadn’t gotten any post-op word yet from the doctor who performed the surgery, but Beau was conversational and in good spirits in the recovery room. Mom, Dad, and I hung around with him, sealed up in medical scrubs. I stayed behind after our parents left to go to a nearby conference room, their Secret Service detail posted throughout the building.

  Having sat in too many hospital rooms with Beau during the past year, I noticed something flashing on a monitor that I knew wasn’t good. I don’t remember the metric it measured, but I do remember it was way too high. The surgeon spotted it the moment he walked in. His face flushed with alarm and he motioned for me to leave the room with him.

  In the hallway, he said he was concerned. The surgery was technically exacting, essentially requiring him to thread a needle from the base of the skull and through the brain to deliver the agent into the tumor. Any variance as it passed through tissue could damage a critical component of the brain. He worried, as he put it to me then, “that I might have clipped something I shouldn’t have.” He wanted to review the data with his peers and raced off.

  As we waited for him to return, Beau kept asking if something was wrong. I told him it was nothing, that the doc would be back any minute.

  Five minutes passed. Then ten minutes. Then half an hour—at least that’s how long the wait seemed to drag on for the two of us inside that white sanitized room. I didn’t want to leave Beau, but I finally stepped outside and called Dad. In a panic, I told him I thought something had gone drastically wrong, that the doctor had disappeared and that couldn’t be good. Dad chuckled: the doctor was standing beside him. The vice presidential protocol—alerting my dad before anyone else on matters that involved him directly—was followed in such situations and sometimes, like now, it left me in the lurch. The doctor had just given my parents a briefing and said that everything was fine.

  It didn’t stay fine for long.

  Flown back to Delaware a few days later, Beau had one good night at his house with Hallie and their kids. The next day Hallie called me frantically in Washington to say Beau was unresponsive. I drove to Wilmington and went straight upstairs to his bedroom, where he hadn’t reacted to anyone all day.

  Beau looked agonized, out of it. He barely said hello when I walked in. I kissed him and asked what was wrong. He lifted his hands barely a fraction of an inch, shook his head slightly, then rasped, “I don’t know.” I suggested he get out of bed, but he resisted. “You have to,” I told him. “It’s a beautiful day. Let’s go sit on the porch.”

  It took forever to get him up. He could hardly move—he was clearly in pain and anxious because he had so little motor function in his arms. I carried him gently down the steps, ferrying him more like a young son than an older brother, gliding past Mom and Dad to French doors that opened onto the front porch and looked out over a pond. We sat in chairs set right inside the open doors, just the two of us.

  I didn’t say much except to tell him it was going to be okay, that this is what the doctors told us would happen, that injecting the virus would cause a firestorm in his brain before it started to work and the white cells attacked the tumor. I told him it was temporary, that he just had to make it through this rough patch before things turned around. Again, he nodded his head just a bit. I could tell he was listening intently and wanted to believe everything I said.

  I don’t know how many minutes passed without either of us saying a word. But at some point, Beau seemed to point at a new watch I was wearing. It took me a minute to grasp what I thought he was getting at. One night when Beau was maybe fifteen, before a high school dance, he sneaked into Dad’s keepsake box in the top drawer of his walk-in closet. There he found a pair of stainless steel cuff links and a 1960s Omega watch, with a leather strap, that Beau believed our Dad had been given by our mommy, the term we both used into adulthood for our mother, Neilia (we called Jill, our stepmother, “mom”).

  He thought the watch was so cool. So he wore it that night, without asking Dad. He planned to put it back in the box when he returned home, but he somehow lost it at the dance, to his eternal regret. He never told Dad, and Dad didn’t even notice it was missing until long after. I’d forgotten all about it. But Beau remembered. He felt guilty about losing that watch forever.

  Decades later, as we sat together during one of his endless-seeming hospital visits, Beau started searching for another watch to replace it. Finding a replica became an obsession for him during those months when we spent so much time waiting around—at doctors’ appointments for tests and scans, in airports waiting for flights. He and I hunted everywhere, with no success. We looked online on our phones, scrolling through thousands of pictures. It was a way for us to pass the time and focus on something else entirely. I didn’t even remember what the damn thing looked like, but Beau did. He recalled it exactly.

  Now he seemed to gesture at my wrist. The watch I wore was an Omega Seamaster, with a metal band. I’d bought it for Beau at some point but knew he wouldn’t wear it. Now it looked like he wondered why I’d gotten it—it wasn’t the one we were looking for. I laughed. It was so comforting to see Beau firing enough to make an offhand observation that had nothing to do with how awful he felt.

  We settled into another long, serene silence. We stared out at the landscape that unfurled before us—the green and gold of the Brandywine Valley in all its fresh spring glory, the glassy pond, the colossal red oak believed to be the oldest in the state.

  Beau finally turned to me, his voice barely audible.

  “Not the watch,” he whispered, indicating that my Omega wasn’t what he had pointed to earlier. Instead, he had been trying to point past me, at the panorama in front of us, but couldn’t lift his hand high enough.

  “Beautiful,” he said now, nodding toward the landscape. “Beautiful…”

  They were the last words my brother ever gave me.

  * * *

  I carried Beau back upstairs, slipped him into his bed, propped up his pillows, kissed him. I told him I’d be back in the morning.

  Before then, however, I got another call: agitated and excruciatingly uncomfortable, he’d been taken by ambulance back to Thomas Jefferson in Philly, where my sister Ashley’s husband, Howard Krein, is a surgeon. Beau’s condition wasn’t getting significantly worse, but he wasn’t getting better, either. A few days later, he was transferred to Walter Reed, with the hope that some rehab might help him to improve.

  When I walked into his room there, Beau was clearly suffering; he clutched his abdomen in utter noncommunicative agony. It seemed to take forever to get hospital personnel to respond. As he was going septic, almost dying right then, he underw
ent surgery for a perforated bowel. They soon moved him to the neurological ICU, where doctors eventually decided to intubate him.

  A little more than a month had passed since our time together in Houston, yet it felt like a lifetime ago. I planted myself in the chair beside Beau’s bed. His wife, Hallie, camped out in the room that was cleared for her next door. She’d go to sleep there around midnight, be back up at 5 a.m.

  Beau’s tracheostomy tube was removed after doctors told us they’d determined recovery was no longer possible, and we waited.

  * * *

  Time slid by. Beau didn’t stir. I kept talking. I told him it was okay to let go now. I told him that his children, Natalie, almost eleven, and Hunter, nine, would be fine, that they had the whole Biden clan there to look after them, just as we did when Mommy and Caspy left us when we were so young.

  I told him Dad would be okay, too.

  “He’s so strong, Beau,” I said. “He knows he has to be strong for all of us.”

  I promised him I would stay strong as well; he’d gone with me to my first AA meetings, found my first sponsor, and escorted me to rehab enough times to know what a tall order that was. I promised him I would stay sober. I promised I would take care of the family as he always had. I promised I would be happy and live the beautiful life we imagined together.